A 5-year study reported novel benchmark cut-off values for outcome parameters in patients who undergo surgical resection for perihilar cholangiocarcinoma (PHC), with only 39% of patients qualifying as benchmark cases.

Main benchmark cut-offs included grade 3 postoperative surgical complications after 3 months ≤ 70%, successful R0 surgical resection ≥ 57%, bile leak rate ≤ 47%, overall survival of 5 years ≥ 39.7%, postoperative liver failure ≤ 35%, complications following resection assessed by the Comprehensive Complication Index (CCI) ≤ 30.5%, a mortality rate after 3 months ≤ 13%, and an in-hospital mortality rate ≤ 8%.

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Investigators noted that out of 24 high-volume centers spanning 3 continents, centers in Asia reported the best surgical outcomes. Additionally, they observed that the centers that handled the surgeries involving the most complex cases reported better postoperative outcomes, especially lower post-operative liver failure rates, compared with the centers operating on less complex cases (4% vs 13%, P =.002).

As a result of their study, the authors remarked that while “surgery for PHC remains associated with high morbidity and mortality…the availability of [these] benchmark values…may serve as key references for comparison in any future analyses of individuals, group of patients, or centers.”

Study Methods

Between 2014 and 2018, researchers gathered and analyzed the outcome data from a total of 1829 patients receiving major liver surgery for PHC.

Subsequently, the investigators classified benchmark patients as those who did not require vascular reconstruction due to tumor invasion. Additionally, these patients did not have severe obesity, diabetes, or cardiovascular disease as comorbidities. Lastly, inclusion criteria stipulated a minimum of at least 1 year of postoperative follow-up.

The researchers calculated benchmark cutoff values from the 25th or 75th percentile of the median values of all 24 high-volume centers. High-volume centers were those which surgically treated 50 or more PHC cases during the 5-year study time frame.


Mueller M, Breuer E, Mizuno T, et al. Perihilar cholangiocarcinoma-novel benchmark values for surgical and oncological outcomes from 24 expert centers. Ann Surg. Published online July 29, 2021. doi:10.1097/SLA.0000000000005103